Autonomic innervation and segmental muscular disconnections at the human pulmonary vein-atrial junction - Implications for catheter ablation of atrial-pulmonary vein junction
Autonomic innervation and segmental muscular disconnections at the human pulmonary vein-atrial junction - Implications for catheter ablation of atrial-pulmonary vein junction
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DOI：
10.1016/j.jacc.2006.02.054
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发表时间：
2006-07-04
影响因子：
24
通讯作者：
Fishbein, Michael C.
中科院分区：
文献类型：
--
作者：
Tan, Alex Y.;Li, Hongmei;Fishbein, Michael C.
目的：本研究旨在研究人体肺静脉(PV)-左心房（LA）交界处的肌肉连接和自主神经分布。背景：心房颤动（AF）导管消融的一种方法是将PV肌套与LA分离。消除迷走神经反应进一步提高了成功率。方法采用酪氨酸羟化酶（TH）抗体和胆碱乙酰转移酶（ChAT）抗体，对8个尸体解剖的人心脏采集的192个环心房静脉段（32条静脉）进行免疫组化染色。结果在192个PV-LA连接中有70个（36%）和36个（19%）分别发现了宽度为0.1 ~ 5.5 mm （1.1 +/- 1.0 mm）的肌肉不连续和纤维方向的90度突变。虽然这些各向异性特征在前上接点更常见（p < 0.01），但它们也存在于整个PV-LA接点周围。自主神经密度在上静脉前上段最高（p < 0.05），下静脉下段最高（p < 0.05），距PV-LA交界处5 mm以内的LA最高（p < 0.01），心外膜高于心内膜（p < 0.01）。肾上腺素能神经和胆碱能神经在组织和细胞水平上高度重合。相当比例（30%）的神经节细胞表达双肾上腺胆碱能表型。结论：大约50%的PV-LA节段存在肌肉不连续和突然的纤维取向改变，为重新进入创造了重要的底物。肾上腺素能和胆碱能神经在PV-LA连接处的5转内密度最高，但高度重合，表明在消融过程中不可能选择性地靶向迷走神经或交感神经。
OBJECTIVES This study sought to examine the muscle connections and autonomic nerve distributions at the human pulmonary vein (PV)-left atrium (LA) junction.BACKGROUND One approach to catheter ablation of atrial fibrillation (AF) is to isolate PV muscle sleeves from the LA. Elimination of vagal response further improves success rates.METHODS We performed immunohistochemical staining on 192 circumferential venoatrial segments (32 veins) harvested from 8 autopsied human hearts using antibodies to tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT).RESULTS Muscular discontinuities of widths 0.1 to 5.5 mm (1.1 +/- 1.0 mm) and abrupt 90 degrees changes in fiber orientation were found in 70 of 192 (36%) and 36 of 192 (19%) of PV-LA junctions, respectively. Although these anisotropic features were more common in the anterosuperior junction (p < 0.01), they were also present around the entire PV-LA junction. Autonomic nerve density was highest in the anterosuperior segments of both superior veins (p < 0.05 versus posteroinferior) and inferior segments of both inferior veins (p < 0.05 vs. superior), highest in the LA within 5 mm of the PV-LA junction (p < 0.01), and higher in the epicardium than endocardium (p < 0.01). Adrenergic and cholinergic nerves were highly co-located at tissue and cellular levels. A significant proportion (30%) of ganglion cells expressed dual adrenocholinergic phenotypes.CONCLUSIONS Muscular discontinuities and abrupt fiber orientation changes are present in > 50% of PV-LA segments, creating significant substrates for re-entry. Adrenergic and cholinergic nerves have highest densities within 5 turn of the PV-LA junction, but are highly co-located, indicating that it is impossible to selectively target either vagal or sympathetic nerves during ablation procedures.